ByAleszu Bajak, Guest bloggerJanuary 21, 2014

Jerome Valcke, Secretary General of FIFA, inspects the Arena de São Paulo stadium, in São Paulo, Brazil, Monday, Jan. 20. Members of FIFA and the 2014 World Cup Local Organizing Committee started an inspection tour of stadiums in host cities across Brazil.

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São Paulo, Brazil — Hundreds of people were forced from their ramshackle homes in the heart of São Paulo this month, as legions of garbage men dismantled informal shelters scrap by scrap. The city government decided to break up the shantytown just blocks from the municipal theater where the symphony plays. Referred to commonly as Cracolandia, or Crack Land, it takes up several downtown streets in this city of 11 million. Some 400 displaced squatters will be funneled into motel rooms and a state-run treatment program called Operation Open Arms.

But the timing of the initiative – and the nine-month duration of the subsidy and treatment regimen – has some critics accusing São Paulo officials of focusing more on beautifying the streets before the June kick-off of the World Cup than providing this population with long-term solutions for rehabilitation, job training, and housing.

“By taking down the structures, you’re not solving the problem,” says Marcela Pontes, a young physician working at an area clinic, and charged with tracking down many of her patients in the shantytown. Brazil's public health system recruits community health teams to follow up on the most at-risk patients. HIV and tuberculosis is rampant in this population, so offering treatment is a priority. Plenty fall through the system, though.

The shantytown is made up of close to 2,000 people and is rife with the sale and use of crack cocaine. Because the city plan only targets about 400 residents, many say the shantytowns will inevitably grow back, as it has in previous years. The settlement has long been viewed as a public health risk and a symbol of poverty here in the city center.

“They are really here because of poverty, not crack addiction,” says Flavio Falcone, a doctor working in the shantytown today (and dressed up like a clown – a tactic he says helps him build relationships here, á la Patch Adams). “They were born in the slums, arrested, left jail, and came here,” Dr. Falcone says of many of his clients who reside here. And the “crack problem” may not decrease with the clearance of this space. Plenty of people don’t live in the razed shacks, but instead travel from all over the city seeking out drugs.

Falcone works a couple blocks from the settlement in a publicly-run health clinic. There, walk-ins can receive treatment for HIV, sexually transmitted diseases, or pneumonia and tuberculosis. Brazil’s public health care system is universal and free, and most community clinics employ physicians, psychiatrists, dentists, and psychologists as well as social workers. The quality of the clinics were a point of criticism, however, during last summer's large-scale protests across Brazil.

Many academics point to the successes of harm reduction strategies like the city's here for combating crack cocaine and the associated diseases in marginalized populations. But in the end, residents here are a socially excluded population, says Dartiu Xavier da Silveira, a professor of psychiatry at São Paulo's Federal University. They likely won't take to treatment the way academic papers project they will.

“The mayor proposes things people like to hear, not things that are really effective,” Mr. da Silveira says. Still, he believes harm reduction strategies can wean addicts off of crack if long-term treatment programs are implemented.

By 9am last Wednesday, people were filling bags with the few belongings they have: stained blankets, foam mattresses, a broken television set, a stuffed animal. Some piled suitcases into shopping carts, while others loaded up wooden rickshaws. Up the street from the four-block squatter community, a fleet of garbage trucks were loaded with the scraps of plywood and plastic sheeting the squatters’ shacks were built with.

With a wide hose and pump, cleanup crews slurped away backed up sewage, with the stench made stronger by the hot mid-morning sun. Helicopters flew overhead, and a gold-plated haloed Jesus watched over the occupation from a church steeple, a shiny reminder of redemption.

The city’s health ministry gave the community – which has existed in some capacity for more than two decades – one week’s notice that homes there would be razed. This wasn't the first attempt at clearing this community, but the operation of Jan. 15 was notably more peaceful that previous operations.

Some tenants were more resigned about the forced mobilization than others. Helio Alves Prado has lived in the shantytown for the past two months, though he's been in downtown São Paulo, using drugs, for four years. He moved his belongings quietly, but others weren't as subdued. Milerson Smith, a South African who has been in Brazil for eight years, complained boisterously in English that the removal of the shacks was discrimination and that she and other African immigrants weren't guaranteed spots in the motels.

The city-sponsored resettlement plan will provide 400 squatters three meals, $6 a day for community service and lodging in nearby motels in exchange for going to treatment.

- Aleszu Bajak is a Knight Science Journalism Fellow at MIT, and recently spent three weeks in Brazil with support from the Knight program and the Harvard Global Health Institute.